NPIMap

Organization Active NPI

Kids Health Alliance PA

  • Rural Health Clinic/Center
  • Ocala, FL
National Provider Identifier
1467619676
Registry record updated Jan 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KIDS HEALTH ALLIANCE PA
Practice address
2650 NW 2ND St Ste 100
Ocala, FL 34475-6234
Phone
(352) 237-5400
Fax
(866) 260-5182
NPI assigned
May 16, 2008
Last updated
Jan 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shahab Eunus, MDNPI 1619085610
Title
Ceo/Medical Director
Phone
(352) 598-2479

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Pediatrics Physician 208000000X NU
Pediatric Adolescent Medicine Physician 2080A0000X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

2650 NW 2ND St Ste 100
Ocala, FL 34475-6234

Mailing address

7960 SW 60TH Ave Ste 100
Ocala, FL 34476-6457
Phone (352) 237-5400

Other identifiers 3

IdentifierTypeStateIssuer
103933OtherPTAN
023548301MedicaidFL
023548300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120113000465 FL Part A Provider - Rural Health Clinic 6800063884 Practice locations: Ocala, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467619676. Details of each certification follow.

Rural health clinic certification: CCN 103933

Legal name
KIDS HEALTH ALLIANCE PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 24, 2012
Last certification
Jan 29, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Nov 15, 2006 in FL
Enrollment address
2650 NW 2ND St
Ste 100
Ocala, FL 34475-6234

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0935250Kids Health Alliance PA2650 NW 2ND Street, Ocala, FL 34475Certificate of waiverOct 23, 2027

National Provider Directory

National Provider Directory

Locations

2650 NW 2nd St
#100
Ocala, FL 34475
Phone (352) 237-5400

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Svetlana Y Rogozina Individual 5% Or Greater Direct Ownership Interest Apr 1, 2019 49%
Corporate OfficerVice President Apr 1, 2019 49%
Shahab Eunus Individual 5% Or Greater Direct Ownership Interest Dec 31, 2017 51%
W-2 Managing EmployeePresident Dec 31, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674172800000",
    "number": "1467619676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7960 SW 60TH AVE STE 100",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344766457",
            "telephone_number": "352-237-5400",
            "fax_number": "866-260-5182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 NW 2ND ST STE 100",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344756234",
            "telephone_number": "352-237-5400",
            "fax_number": "866-260-5182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS HEALTH ALLIANCE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A",
        "authorized_official_last_name": "EUNUS",
        "authorized_official_first_name": "SHAHAB",
        "authorized_official_title_or_position": "CEO/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "352-598-2479",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "103933",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023548301",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023548300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocala, FL

Sources for this page

Verify at the official NPI Registry.